It is estimated 8,000 women die every year during child birth and there is increased newborn deaths within Tanzania. The situation is attributed by the wide spread Human Resource for Health shortage estimated at 68%, which also contributes to only 47% of mothers delivering at the health facilities. (Tanzania Demographic Health Survey- 2004/5).

In attending to the above situation, the Benjamin William Mkapa HIV/AIDS Foundation (BMAF) initiated in 2009 a project which aims at improving lives of pregnant mothers and their newborns residing in Singida region. The project famously known as Saving Lives of Mothers and Infants ( Okoa Maisha ya Mama na Mtoto – in Swahili) completed its first phase in June 2010 after undertaking interventions for 18 months.


The initiative is implemented in partnership with the Ministry of Health and Social Welfare (MOHSW) and the regional and districts teams of Singida and Iramba district councils. World Lung Foundation financially supports the project with Ifakara Health Institute being the administrator of the grant on behalf of WLF.
It is the two rural Health centers of Ikungi and Ndago from Singida Rural and Iramba District Councils respectively, that benefited from this first phase of the project to enable them improve quality of Emergency Obstetric Care (EMOC) services.


Emergency Obstetric Care at Rural Health Centre- Reaching out to the community

The project successfully trained eight (8) health staff on Life Saving Skills whereby none of them had ever received this training before. Skills gained gradually contributed positively to maternal
and newborn health outcomes. Presence of two Mkapa Fellows who were Assistant Medical Officer and Medical Officer contributed significantly to ensuring availability of skilled professionals to assist the clients and other health staff.

Health staff receiving oral and practical training on Emergency Obstetric Care

Quality improvement in health care was further made possible through the periodic technical supportive supervision provided by the District health team and Gynaecologist from the Regional Hospital or from the Mkapa Foundation.
Coaching and mentoring of the trained staff was applied throughout the supervision visit.



Notable improvement in managing facility data at the health centres was registered however still this is an areas requiring further support for effective data collection, analysis and utilisation thus contributing to improved mothers and newborn health care.


Both centres were enhanced with basic medical equipments that aimed to improve quality of provision of basic obstetric care as well as to support emergencies.


BMAF staff handing over equipments to the Singida health authorities

In-order to improve quality of care, the project expanded and rehabilitated the maternity ward of Ikungi health centre which ensured privacy and comfort of mothers being delivered at the facility. In addition, the rehabilitation has motivated health staff in providing services in a conducive environment.

The situation of Ikungi maternity ward before rehabilitation

After Rehabilitation – Enhancing quality care: Women being delivered in clean and comfortable environment

Mother being attended by BMAF staff during field visit at the newly renovated Health Centre.

CHALLENGES:
The shortage of skilled health professional is a major bottleneck in provision of quality health care to mothers and children especially when it entails attending to emergency obstetric care. Weak attraction and retention strategies of health workforce as well as un-conducive working and living environment attribute to this crisis.
Staff house in Ndago health centre

KEY MESSAGE:
Women and Children play a crucial role in development of Tanzania thus investing in their health is not only the right thing to do- it also builds stable, peaceful and productive societies. In-order to save their lives, partnership between public and private entities is pertinent. In addition health systems strengthening, particularly Human resource for Health is an essential component to be integrated in maternal and newborn health initiatives.



Produced by: Benjamin William Mkapa HIV/AIDS Foundation, September 2010. For further information visit: www.mkapahivfoundation.org; Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

1.The Foundation has enhanced its partnership and support to the Government of Tanzania through its respective Ministries and Institutions by providing technical assistance to various activities.

:: BMAF is playing facilitative role in conducting joint meeting between MOHSW and PMORALG (involving Directors related to HRH) whereby the two HRH innovations and other HRH policy and strategic areas are further discussed.

:: BMAF has continued to be an active member within the Health Sector Wide Approach Technical Working Groups related to HRH and Regional Health Management Team Strengthening; whereby experiences and lessons learnt from the two HRH programme has been sh ared. Furthermore the Foundation participated in development of HRH component in the next Health Sector Strategic Plan III ( 2009 -2015).

:: Through the National Task force, BMAF actively provided technical and financial support to the Ministry of Health & Social Welfare on the launching of the National HIV testing campaign that was initiated and led by our President Jakaya Mrisho Kikwete in July 2007.

:: The Foundation together with other Partners including Tanzania AIDS Commission, has been actively involved in the preparation of Country Proposal Global Fund Round 8 through being part of the proposal writing team, peer reviewers and attendance in the Tanzania National Coordinating Mechanism meetings. Role played by the Foundation included provision of technical assistance on the area of health syste ms strengthening component whereby HRH was one of the subcomponent.
Similarly the Foundation is actively involved in the preparation of Global Fund Rd 9 Country proposal development, a process led by TACAIDS.

:: Mkapa Foundation spear headed the process of improving the HRH component of the National Supportive Supervision Guide by collaboration closely with the MOHSW and Capacity Project including holding a consultative stakeholders meeting to obtain inputs focused on tool improvement.

:: In the process of mainstreaming Fellows to the Public Service, the collaboration between BMAF, PMORALG, POPSM and MOHSW has been the key to obtaining employment permit of 61 Fellows into Public Service for the FY 2008/9.

:: In the spirit of strengthening health systems of remote districts, the Foundation donated 5 vehicles to the districts of Micheweni, Kilindi, Simanjiro, Kilolo and Mpanda through the financial support of Norway Embassy, Clinton Foundation and Abbott Fund, an event which was honoured by the Prime Minister, His Excellency Mizengo Pinda.

Photo: Prime Minister Pinda igniting one of the vehicles as a gesture of testing its road worthiness. The vehicles were procured by BAMF through the financial assistance from Norwegian Government and Abbott Fund.

2. The Foundation in collaboration with the Ministry of Health and Social Welfare and Ifakara Health Institute is embarking into a maternal health related intervention namely Saving Lives of Mothers and Infant that will benefit the Singida rural and Iramba District Councils.
The initiative is financially supported by the Bloomberg Foundation of the United States of America and it will focus on building capacity of health centres to provide obstetrical care through renovation, equipping and improving working environment. In addition it will focus on capacity development of existing health professionals on Obstetrical and Neonatal care through the Mkapa Fellows working in the respective districts. Close linkage with the District and Regional Hospitals and the Community around, will be the key strategy during its implementation. The project is anticipated to begin in November 2008.


3. To be able to document evidences of the programmes implemented by the programme and the existing health systems, the Foundation identified areas requiring further operational research. The findings from these researches will be shared with key stakeholders in order to inform policy and enhancing national strategies for provision of quality health care by motivated and qualified health workers.
Foundation is currently undertaking two operational research, one being assessing the capacity of Council Health Management Team and Hospital Management Team on Human Resource Management in selected 6 districts. The other is comparison assessment on the effectiveness of contractual vis a vis permanent employment of health workers with the focus on underserved districts.